Provider Demographics
NPI:1780757260
Name:HART, ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 108TH LN NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5268
Mailing Address - Country:US
Mailing Address - Phone:763-253-7777
Mailing Address - Fax:763-253-7779
Practice Address - Street 1:2331 108TH LN NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5268
Practice Address - Country:US
Practice Address - Phone:763-253-7777
Practice Address - Fax:763-253-7779
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C237HAOtherBLUE CROSS BLUE SHEILD
MN3C237HAOtherBLUE CROSS BLUE SHEILD